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' FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.__....-- -------------------------------------- (Complete in Triplicate) -------------- Date Issued--- Y '-77 5 This Permit Expires 1 Year From Date Issued t --------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describec`F This application is made in compliance with County Ordinance No. 54 and existing Rules and Regulations: r Xa- :C� ENSUSTRACT Q .-- t JOB ADDRESS/ OCATIO = 01-,_5 - } Phone ------- ---- Owner s Name � H ! ------------------------- C r z Address--- -- � ----------------- ------------- ----=------------ -City---- ----------------- CE h ---- -- ontractor s Name� X'e/� ---- ----------------- ------ cense # ---- , Phone Com ercial Trai er Court ❑ Installation will serve: Residence ❑ A'partment House❑ ❑ E Motel ❑ Other--- i � �� 's ' {� _- : _--Garbo a Grinder .- -._ — Lot-Size-- ��"+3- � 1 Number of living units.-;V,4_ Number of bedr_ooms� g "" e # ---------------- --------------------------- Water --------------- -Prwat Water Supply- Public 5 stem and-name-__---- -_ ----------------------------- Sand - ---------- ^ pp Y� Y. - ---- - -- --- - - -- •�f � f i ` Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ meat ❑' !Sandy Loam Clay Loam ❑ Hardpan Adobe ❑ Fill Matericil. I ye , type_ (, ( 110 (Plot plan, showing size of lot, location of system in relation to wells, buildin�gs,.etc, must be placed on reverse side.) 4 NEW INSTALLATION: (No septic tank or seepage pit permitted if ' ulp sewer is available within 20; feet,) SEPTIC TANK [ l '"__ Liquid Depth---------------------PACKAGE TREATMENT .[ } Sizel✓ Material --- -------- Capacity/liC `TYp �@��`� �4e -- --No. Compartment_ --- o ` �! ------- - 6. --'-Foundation_ -•---- ------------Prop. Line--`- ------- ------ r Distance to nearest: WelL______�__ - - -4�� , f 3 f_"_______ _ _ LEACHING LINE [ ] No. of Lines_:_--1--------------------Length of each line__---__ - _ ___.__-,.__,_.Total Length __.. U-- �1 `� D' Box-- -----Type Filter Material h-�---,"Depth Filter.Materiall -------------- 1. i Distgnceto nearest: We ---r-__--Foundation______---------------------Property Line_ - -'--- --- --- S� , i l No z Rock F' led Yes. SEEPAGE PIT [ ] Depth—A2_-J ---Di ueter-'�X/Z-Number_ ---f--------------------- I Ei A0 ------ ----------Rock Size_.1��-----a---------------- Water Table.Depth--- ------------- kr LinEi.-Ajc�;-- to nearest: Well-;__ -- --------- }-----,Foundation_ --Q_- '-- -----Prop- Line t 06- REPAIR/ADDITION (Prev, Sanitation Permit _ __.."--------------------------- / : - { Sepfiic Tank (Specify Requirements)_- rGrcJG' ,�-- g "_ 0-� ------------------ ---------- ----------- Disposal � �-f --- Field (Specify Requirements)-...S-7— - -- - ..�: ------ ----------------- - ----- - --- ---- ------------------------- -------------------------- --- -,- -------------------------------- -- i ----------------------------------------- -; - --------------------------- , +wMa Draw existing and required additionn on reverse' I hereby certify that l have prepared.this application and that;thewrk will bedone:'in�ac;ordance'with San Joaquin County and Regu nsrof ti e San Joaquin Loc#al Health District. How owner or licensed agents Ordinances, State Law, and.AR"ules signature certifies the following: C.C. . x II his permit is issued, I shall n�Hmploy,*any person in such manner as "I certify that in the performance of the work for which t pt to become subject to ;Workman's Coropensatio+i, laws of California."INor s Owner Signed- � 7----Owner . iFc rte---- -- ------ - -- - j - - --- .-------- --Title -- ------ --------------- By ............ 741 L (If other than owner) i OR DEPARTMENT USE ONLY oe - -- - -------------------- ------- DATE.- ---------'- -- APPLICATION ACCEPTED BY------- __ �_-__ _ - - DIVISION OF LAND NUMB _------------------------------ ------------------------------------- --- ------------------ DATE -- -- ------- ------ ------- -------- ADDITIONAL COMMENTS-----------------------------"------------------------------------------ - --------=--------- -------------------------- ------------ ---------------------- --- -- -- F85216- - - ----- -- -Date- �-------- - --------- - ---- Final Inspection by 77 R EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT